For a Canadian, no issue in recent years has provided as much insight into America's factious political culture as Barack Obama's attempt to reform the country's health-care system.
A year after the President signed the Affordable Care Act into law, the legislation's commendable objectives remain as obscured as ever by the contentious (for Americans) means it employs to achieve them.
So, instead of celebrating the law's first birthday, the White House is playing down what Democrats had fittingly billed as the most expansive piece of U.S. social legislation in more than four decades.
"It's proving a lot harder to implement this statute than I really expected," conceded Timothy Jost, an expert in health law at Washington and Lee University in Lexington, Va. "The political resistance has been tremendous and has been reasonably effective."
By the time Mr. Obama took up the mantle of reform, figuring out how to provide health insurance for the uninsured masses - now numbering more than 50 million - had been a goal of every American president since Harry Truman. Though Democrats usually tried harder, none had come close to selling Congress on a plan until Mr. Obama came along.
But whether his law survives his presidency is another matter. Republicans still pledge to repeal it. The Supreme Court could spare them the trouble if it strikes down the law's core provision - that every American carry health insurance by 2014 - as unconstitutional.
Polls show that about two-thirds of Americans are against such a mandate, which is baffling to most Canadians. Why would anyone actually want to go without health insurance?
The truth is, they wouldn't. But the second the government tells Americans they must do something - for the good of themselves and society - it overexcites their anti-statist senses.
"It has been portrayed as some massive invasion of individual liberty and become a cause célèbre for the right wing," explained Prof. Jost, a proponent of the legislation. "But basically, all the law is saying to people is 'be responsible, don't be a freeloader.'"
The mandate is the linchpin making the law's more popular provisions - yes, there are a few - possible. One of them prohibits insurance companies from denying coverage to people with pre-existing medical conditions.
But the ideological sparring has overshadowed a legitimate debate over whether the law will improve America's fragmented and ruinously expensive health system or just make a bad situation worse. In 2009, U.S. health spending accounted for 17.6 per cent of gross domestic product, compared with 11.9 per cent in Canada.
Politically, a single-payer system similar to Canada's was never an option for Mr. Obama, even though Americans already have government-run health plans for seniors (Medicare) and the very poor (Medicaid).
ObamaCare, as it is (mostly pejoratively) known, aims to expand coverage by providing tax credits for low- and middle-income earners to purchase private insurance and by lowering eligibility requirements for Medicaid. By 2014, insurance companies will be prohibited from imposing annual limits on the amount the insured can claim in health-care expenses.
How Mr. Obama can claim to do all of this without increasing either the federal deficit or overall costs is a mystery. Already, his administration has been handing out hundreds of waivers, exempting plans from the phased-in elimination of benefit limits to avoid a punishing spike in premiums.
The 2,400-page law is a policy wonk's dream. But like most legislation written by earnest technocrats, its logic works better in theory than it is ever likely to work in practice.
"Just about every idea that anybody has ever had for how to control health care costs is in this legislation," Prof. Jost noted. "Whether any of them will work effectively or not, we don't know."
Still, there is no reason a country as rich as the United States cannot afford to provide health insurance for all of its citizens. That it took 44 presidents to get this far has earned ObamaCare the right to prove itself.
Whether its life expectancy extends beyond the 2012 election, however, is one for the political actuaries.Report Typo/Error